MEDICARE: DR. AREZOO KHANZADEH PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810005056	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0810005056	OTHER	VA	LICENSED CLINICAL PSYCHOLOGIST

General Provider Information

NPI Number	:	1528468741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AREZOO KHANZADEH PSY.D.

Provider Business Mailing Address
First Line	:	3516 PLANK RD
Second Line	:	SUITE 6C
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-6861
Country	:	US
Telephone Number	:	540-388-2891
Fax Number	:	540-412-0223

Provider Business Practice Location Address
First Line	:	3516 PLANK RD
Second Line	:	SUITE 6C
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-6861
Country	:	US
Telephone Number	:	540-388-2891
Fax Number	:	540-412-0223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	05/05/2016

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